Tuesday, December 29, 2009

A young and attractive childcare teacher cum part-time model turned up at our clinic with an interesting problem.

Her main complaint was tilted right incisor. She could not put on braces as it would affect her modelling assignments.

Apart from a tilted incisor on the right side, she also has a retained baby tooth in the canine position

The tilted tooth affects her smile very significant.

An xray solves the mystery. The patient's permanent canine decided to lodge itself in the upper jaw bone directly above the right incisor. The "hidden dragon" pushed the root of the incisor backwards (palatally), tilting the crown of the same tooth forward (labially).For those who are not familiar with xrays, we'ce traced the buried canine out for you.

The "hidden dragon" was surgically removed and the defect was filled with bone graft.

The patient was pain free from the second day after surgery. We proceeded to do a root canal on the tilted tooth.

Monday, December 21, 2009

“What? $5 for the soup? Steamboat is supposed to come with soup. How can you charge me for it? It’s not that I can’t afford to pay for the soup. It’s just that this is the most ridiculous thing I’ve heard.”

This was the argument I overheard at the next table. It was between an angry woman in her late 50s and the poor waiter trying hard to explain company policy. You might think that she was shocked by the bill when the waiter showed it to her. But no. She had not even started yet. The waiter was just informing her upfront that they would be charging $5 for the soup.

I was having steamboat dinner with my friend Tsun Han at Fat Fish Restaurant at the Admiral Country Club on a Saturday night. They serve steamboat which included a generous spread of seafood and sliced meat buffet style. Like one reviewer said, “the prawns were so fresh that they squirm”. The staff was also friendly and attentive. The ambience was pretty good without being packed with noisy crowds. Well, at least it wasn’t noisy until Madam Soupless turned up and complained about the $5 soup even before she started.

Let’s see. The restaurant charges $22.80++ per person which was cheap. Adding $5 to the total bill would mean an additional charge of only a little more than a $1 for 4 people. So would Madam Soupless be happier if she were charged $25 (2 people at her table) with no mention of soup cost?

The restaurant’s policy is just an example of itemised charges promoting “transparency”. If charging Madam Soupless $5 was enough to freak her out, I wonder what would happen if the restaurant gave her a bill which looks like this:

Food $18Soup $5Utensils $1Gas $1

$100 + $7 GST is ridiculous? $107 no GST is good? Look who is being not just ridiculous but also stupid.

Monday, December 14, 2009

Most implants are placed into bone which has already healed over the extraction socket. This requires surgery. The gums have to be cut, a flap retracted and bone has to be drilled. The retraction of a gum flap almost always results in some pain and swelling.

To make the surgery less invasive, some dentists do it flapless. In other words, they drill straight through the gums into the bone without cutting and reflecting a flap. After the flapless operation, the patient tends to feel less pain. However, flapless surgery is “blind”. The surgeon will not be able to see if there are any perforations beneath the gums. Where bone thickness is not ideal, flapless surgery may not be safe or even possible.

What about inserting an implant into an extraction socket immediately after the extraction? If possible, the advantages are obvious. First, the patient does not have to go through implant surgery at a later date. It is flapless and relatively atraumatic. It is usually a one-stage surgery where no further surgery is required to expose the implant. As implants take 2-3 months to integrate, placing it at the time of extraction shortens healing and restoration time.

What is not so obvious, is the technical difficulty of placing an implant into an irregularly-shaped socket. When you drill a hole into a clean wall, you can control the exact depth and width of the hole. When you drill into an existing hole, it’s very difficult to control the final shape and size of that hole. It is imperitive that the surgeon gets good primary stability and is able to place a wide, socket width healing abutment over the implant at the end of the surgery. The success of immediate insertion depends very much on the surgeon’s skill and experience. It also depends on the condition of the tooth.

Immediate placement is not recommended when.

1. There is pus and acute infection.2. The tooth is very shaky with advanced gum disease.3. Surgical removal of the broken tooth is necessary.

The conditions for immediate placement are very similar to the conditions for required for socket preservation with Alvelac bio-scaffold. As long as the socket is walled with bone on all sides, immediate implant insertion is possible. Forget about socket preservation. The immediate placement of the implant provides socket preservation, fewer surgeries and shorter healing time without additional costs.

Tuesday, December 8, 2009

Who are have a missing some of their teeth first choice is denture but is depending on the type of dentures are chosen for our clinic we have 4 types of dentures to sevice you like partial denture , chrome denture, flexible denture and Titanium denture. If you are looking for budgets denture, partial denture are affordable option for you.

But most of our patients concern about how long do we need get ready for a new denture for them. The answer is about 3 weeks to get ready for issue.

First of all, you need to call to make an appointment , consultation with the dentists. The 1st appointment consists of an oral examination and and a set of impressions of the upper and lower edentulous ridges. It takes 2 to 3 days to go for the 2nd visit.

The 2nd appointment consists of deciding how "long" to make the teeth, determining the plane of the tooth setup, and the bite of upper and lower teeth so that when you bite together, the upper and lower teeth line up correctly. This is called "wax-bite".

The 3rd appointment is called the "wax try-in". When the lab returns the loosely fitting tray from the 2nd appointment with the actual final plastic teeth lined up along the outer edge of the wax rim. The wax try-in looks just like a real denture, except that the base fits loosely on the gums, and the teeth are embedded in wax instead of plastic.

The 4th appointment is for the issue denture. So that when the patient walks out of the clinic with new dentures.

For a cost of denture our clinic starts from a few hundred dollars to a few thousand dollars you can call us for enquire.

Tuesday, November 24, 2009

The internet allows people we have never met to become our patients. It often starts off with an enquiry. This is followed by a consultation, a discussion and finally, treatment planning and finally the actual treatment is done. This source of patients is not to be under-estimated. It’s how we managed to build up a cosmetic dental practice. That was 6 years ago.

In recent months, however, we received a lot of enquiries from people who seemed like potential patients. This may sound like good news, but it isn’t. In the past when trust was easier to come by, a high percentage of people who contacted us via the internet did show up for consultation and treatment. Nowadays, enquiries are much harder to handle. Folks who seem interested try to settle the treatment plan, exact costs, guarantees and number of visits over a few emails. They don’t seem to realise that dentistry cannot be practised online. A lot of details of exact costs, procedures etc cannot be determined without an examination. Even with that, unforseen circumstances may result in a change of treatment plan. Insisting on precise figures is difficult at best and unreasonable at worst.

An example. How much does it cost to do a filling. $80. patient turns up with deep caries involving the pulp. This would require root canal treatment and it’s going to cost much more than $80.

“Can you guarantee that it’s only going to cost $80? No hidden costs.” comes the question by email.

Of course not! How can the dentist tell how bad your condition is and whether a filling is all you need? Don’t these folks realise that as far as I’m concerned, it’s their tooth that is hidden from me and not my costs which are hidden from them.

“I just want to do a filling. If you can’t guarantee that it’s not going to cost more than $80, then I won’t come.”

????????!!!!!!!!

So what if we quote reasonable charges. Some folks may be suspicious why Dentist A charges less than Dentist B. So these folks ask even more questions in an attempt to determine how reliable a dentist is without even turning up for consultation. Some of these questions are irrelevant and some can be downright weird. The more they ask, the more uncertain they become. Someone ought to tell them that the real answers to their doubts don’t show up very well on email. So usually, it back to cost factors. Cheapest practice wins. Not to say that the cheap practices are no good, but what about this thing called trust?

C, a colleague of mine has just been diagnosed with diabetes. His doctor? None other than our schoolmate in JC. The doctor is not an endocrinologist. He is just a GP, but C and his family has been seeing him since he started his own practice more than a decade ago. C’s entire family has not been seeing any other doctor ever since. No matter where they go or how much they charge or what additional tests, medications and procedures they indicate, their pool of loyal patients who see them several times a year follow them. It’s all about trust.

If there’s such a thing as doctor-for-life, is there such a thing as dentist-for-life? I’m sure there are. Quite a few have followed me all the way from Hougang. How do you choose a dentist-for-life then? Simple. Try out a few dentists for simple, non-invasive treatment like scaling. Pick one you like, show up regularly for scaling and develop a close patient-dentist relationship with him/her. He knows you. He recognises the importance of the relationship and is far less likely to do anything “funny” than someone who is seeing you for the first time. So what if there’s no Medisave in his/her clinic? So what if the clinic would only allow a 70% claim of surgical fees? Do you have to look for a clinic that allows a 100% claim (like mine) and shoot 100 questions at me because you don’t trust me? Please go back to the dentist you trust. Entertaining all these doubts, mistrust and reluctance to pay consultation fees is a waste of time for me.

Sunday, November 22, 2009

In this article, I'll give an update on my latest "discoveries" in this ever-changing field.

1. Chairside or DIYNo change here. I always recommend DIY whitening. It's more economical and it works just as well. Some say it works even better than chairside whitening.

2. EffectivenessRecently, a Japanese dentist published a paper on what kind of teeth bleach better than others and I found it a really interesting read. He mentions (surprisingly) that dentine doesn't actually bleach. It's the enamel that bleaches. I tend to agree with that because in many of my bleaching cases where dentine is exposed due to abrasion cavities, that part of the tooth won't whiten.

If it's true that only enamel bleaches, then it will mean that people with worn out and yellowed teeth are unlikely to benefit very much from bleaching. It also means that areas where the enamel is thicker, like near the incisal tip, will whiten much better than the necks of the teeth where the enamel is thinner. Hence, the location of the staining is very important. If the tooth is darker around the tips, then they will bleach well. If they are darker around the gum area, then they may not bleach well.

The bad news is, Asians tend to have thinner enamel than their Causasian counterparts. This means that Asian teeth will not bleach as well as Caucasian teeth. Many of the claims by the manufacturers of bleaching products are actually based on Caucasian teeth.

3. New ProductsFor our DIY kit, we're now using 9.5% hydrogen peroxide. We are no longer using 22% carbamide peroxide. The new product is clearly more effective than the old. Besides that, additives like amorphous calcium phosphate go into the new packaging. ACP has been shown to be capable of remineralising demineralised teeth by cauing calcium phosphate to precipitate. It's supposed to help control sensitivity.

Patient feedback confirms that a reduced level of sensitivity is experienced with the new formulation. Our 9.5% hydrogen peroxide take-home kit is the most popular bleaching kit at our office today. It may take a bit longer than chairside whitening, but it's more cost-effective.

For chairside bleaching, we are still using 38% hydrogen peroxide. Not much "improvement" in that area as hydrogen peroxide in those concentrations is highly caustic. For lasting results, all chairside whitening procedures must be followed up with the take home kit. The way I look at it, there's really no point in doing chairside whitening.

4. Procedures

No change in that department. Impressions are first taken and a set of customised bleaching trays are made. If you book your appointment in advance, the trays will be ready in 1 hour.

The mixing tip is attached to a double syringe. As the plunger is pushed, the two chemicals are mixed together and activated. Each syringe contains enough material for 3 upper and lower applications. 3 syringes give 9 applications.

The activated gel is placed into the customised bleaching tray. The trays are worn over the teeth for one hour 2 times a day. They are quite comfortable and are almost invisible. However, the trays must be pushed in for a snug fit. The flexible tray is pressed against the teeth to clear voids in the gel. Excess gel on the gums is wiped off.

Thursday, November 19, 2009

So what’s new? Wellness Village packed up and left without any warning, Customers who have paid for packages, some just before the spa closed down, are now left in the lurch. When something like this happens, civilised consumers would seek help from CASE.

And here’s the response. Consumers Association of Singapore (CASE) executive director Seah Seng Choon said that he was “not surprised” by the spa’s actions.

“Don’t be fooled by the location. Spas are generally small businesses, unless they have an international chain … Consumers have to be careful when transacting with them,” said Mr Seah.

Huh? Did I get that right? What was Mr Seah (former General Manager of NTUC Denticare) trying to say? That consumers must be careful transacting with small operations like mine? That small establishments are weak, unpredictable or even nonviable in today’s economy? That they should “merge” with or just surrender to NTUC? That dental patients would be safer and better off with the big group practices and establishments employing hundreds of dentists because Mr Seah wouldn’t be surprised if small and humble practices out there fold up and pack up quietly after collecting deposits for crowns and bridges? That the big medical or dental groups going for IPO are somehow more reliable? Big is in, small is out?

OK, so Mr Seah’s comments have drawn some flak and he has bothered to clarify that the numbers show that SMEs are usually the ones that leave customers in the lurch. I don’t think we need to be reminded of that. There are far more SMEs than big companies out there. Of course the failure rate of SMEs will be higher. I think the problem everyone who objects to Mr Seah’s remarks has, is the derisive way in which someone working for one of the largest organisations in Singapore that has put so many pop and mom operations out of business should add insult to injury. And by the way, if a certain ethnic group in the country is more prone to divorce (as shown by statistics), would Mr Seah warn other people from other ethnic groups not to marry them?

Just take a look at the food courts run by the big players. Impressive theme, impressive uniforms, unimpressive food. Chances of finding good hawker food is much higher in small, one or 2-man operated stalls without any designer decor or uniforms. So why is it so difficult for so many of my middle management friends to understand why I don’t belong to group practices with scores of dentists and dozens of branches?

Why are so many seemingly intelligent people so easily impressed by the size of the company providing a service? Is it because we see with our own eyes how the big boys strangulate the little guys as the new generation of consumers place less and less value on personal touch? Will we end up as a nation of employees under one big employer? What happened to the promotion of entrepreneurship? Were those messages only meant for the scholars heading our GLCs?Gosh, I’d better be packing my bags and heading for Cambodia soon.

Monday, November 16, 2009

Today (Monday, November 16 2009) I saw my dental clinic on The Straits Times again, Page C4.I was so surprised when I saw my clinic came out on Straits Times again today . There's many dental clinics in Singapore, but we were so lucky was selected by them for F.O.C. advertising. Thank you so much for Straits Times.

Sunday, November 15, 2009

A patient asked my dentists yesterday why your clinic called “New Age”. My dentists trying to say that he is still young? No, it was Ris Low asking, but the term “New Age” is not well understood by the majority in Singapore. Does it represent youth? Modernity? Not quite.

In fact, a lot of New Age concepts are rather ancient from an Asian point of view. It’s only from the Western point of view that religions like Hinduism, Buddhism, philosophies like Cosmology, Gaia Theory, Yin-Yang Theory, Five Element Theory and practices like yoga, meditation, qigong, various forms of traditional healing are all considered “new age”.

Derived from the rebellious hippy mentality of the 1960s, the New Age Movement represents a rejection of traditional or conventional religious dogma as well as rigid social structures and protocols. In recent years, this rejection extends to the fields of conventional medicine and scientific theories. Unlike the hippies, modern New Age Movement “activists” tend to embrace a more moderate, down-to-earth lifestyle.

Wikipedia:The New Age Movement includes elements of older spiritual and religious traditions ranging from atheism and monotheism through classical pantheism, naturalistic pantheism, and panentheism to polytheism combined with science and Gaia philosophy: particularly archaeoastronomy, astronomy, ecology, environmentalism, the Gaia hypothesis, psychology, and physics. New Age practices and philosophies sometimes draw inspiration from major world religions: Buddhism, Chinese folk religion, Christianity, Hinduism, Islam, Judaism; with particularly strong influences from East Asian religions, Gnosticism, Neopaganism, New Thought, Spiritualism, Theosophy, Universalism, and Western esotericism.

Calling his clinic “new age” has something to do with his interest (He is not an extremist) in the New Age Movement, he inclination towards Eastern religions/philosophies, his belief in TCM, qigong and fondness for New Age music which often include sounds from scorching deserts to the freezing Himalayas.

While our youngsters celebrate Halloween like it’s the coolest thing to do, many young Western professionals in the New Age Movement actually find our Taiji symbol to be the coolest thing on earth.

Tuesday, November 10, 2009

The wisdom tooth is the third last molars. Most people have one in each quadrant of the mouth. However, it is not uncommon to find individuals with less than 4 wisdom teeth.Because this tooth usually erupts when the person is about 18-21 years of age, it is called the wisdom tooth. In reality, the tooth is often non-functional or even problematic.

When there is insufficient space in the jaw for the tooth to emerge fully, the wisdom tooth may get trapped under the gum and bone. Partial eruption makes the tooth susceptible to gum infection which may result in recurrent bouts of pain and swelling. Left alone for long periods, chronic gum infection can lead to fibrous growths or cyst formation.

In certain cases, the tooth may be slanted against the next tooth – the second molar. The resulting gap between the two teeth traps food and promotes bad breath as well as decay

Wisdom tooth surgery is usually carried out to save the second molar or stop the recurrence of gum swelling. In some individuals, the eruption of their wisdom teeth coincides with the appearance of their front teeth being pushed together. Wisdom tooth surgery is also performed to allay fears of crowding/overlapping front teeth, though there is no strong evidence to prove that the crowding front teeth is the direct result of pressure from erupting wisdom teeth.

Payment For Dental Surgery With Medisave

Medisave audits have been driving many dental clinics crazy. Almost no clinic can escape without refunding money due to “over claiming”. It has been and will always be our clinic’s policy to help our patients claim the maximum amount that MOH and CPF Board allow. We are not in the position to dictate or even advise our patients on what to do with their own money.

On the other hand, organisations which regulate the use of Medisave funds have the duty of protecting our patients’ Medisave reserves. The maximum claimable amounts stipulated by MOH are not meant to cover 100% of the bill. As private practitioners, however, we always try our best to charge and claim in a way that results in no cash payment on the part of our patients. Nevertheless, this is not always possible. MOH has very rigid guidelines on the maximum claimable amount for a particular type of wisdom tooth condition. At the MOH side, the evaluation is based purely in x-rays.

After Wisdom Tooth Surgery

You will get Swelling and difficulty when you are open your mouth .bite firmly on the gauze provided for at least half an hour. Take your painkillers before the numbness wears out. Do not keep spitting or rinsing your mouth. Swallow your saliva. Put the Ice/cold packs are very effective in controlling swelling when applied immediately after surgery. Remember to apply it outside your cheek. Never put ice inside your mouth or apply for more than 20 mins at one time. Allow 10 min intervals between ice applications. Please do not smoke, drink very hot drinks or alcohol and do not exercise , exert yourself. Get plenty of rest at home and take care not to bite your lip when it is numb. And last one when bleeding has stopped, eat soft food and keep the wound clean. Remember to see your dentist for the follow up.

MOST IMPORTANT you must take the antibiotics prescribed to you to prevent infection. We will also prescribe and dispense drugs for pain and swelling for you.

Whitening Instructions for who need teeth whiter.floss and brush your teeth. Twist off the clear plastic cap from the syringe and replace with the mixing nozzle. Place a small "teardrop" amount of gel in each tooth compartment in the tray. To guide you, the "gel drop" shown represents the average size drop you should dispense into each tooth compartment. Remember this is a guideline only. if you have small teeth, use a smaller "gel drop". Conversely, if you have larger teeth, use a slightly larger drop.

Place the tray with the gel in the mouth. Remove excess gel with you finger or dry toothbrush. When inserting the tray, becareful not to push the gel out, but be sure that the tray is completely seated. You may see "bubbling" within your trays while wearing them. This bubbling is acually part of the whitening process. Wear trays for at least 30 minutes, but no longer than 60 minutes. After whitening, remove and rinse the trays with cold water. Hot water may damage the trays. If necessary, use a toothbrush to remove any residual gel. Place the trays in the storage case, and store them in a cool, dry place Rinse and brush excess gel form the teeth.

Monday, November 9, 2009

Everyone got their own dream and wish like their good job, good pay and bonus, strive sweep and toto. Of cause, most of us would want to be either a billionaire or millionaire, right?

The some of people who have the own business, they will wish to have a good business, good customers at the mean time also keep hoping and wishing their dream come true.

For me, i still like and enjoy with my work. But what's i wish is ... i wish can get a good patient like today. Suprisingly, we have a walk in patient who came from Holland. Past 3 weeks, her father and her went to Bangkok, Phuket, and PP Island for holiday. Due to "no direct flight" from Thailand to Holland, they needed to transit in Singapore. So they had about 5 hours to shop in Singapore.

She decided to look for a dental clinic to whiten her teeth. Her father told us that because she quited from smoking, so she wants to whiten her teeth. She was so excited. After We explained to her the kinds of whitening teeth treaments, she decided to have whitening chairside which cost her $650 only. During the her treatment, her father was told me that the cost of dental treatment in Holand are much more expensive if compare to Singapore.

The treatment only took her about an hour. She was so happy and satisfied with it.

"YES" Patient happy we also happy too. One of the good patient that i am looking forward...

Thursday, November 5, 2009

This Australian teacher has been brushing his teeth without mercy for many years - so much so that the bristles have worn out the necks of his teeth, causing "furrows" which gradually weakened the teeth.

One day, he bit on something hard and his lateral incisor snapped. We handled the emergency by doing a root canal followed by a temporary post crown built up freehand with flowable composite.As a temporary measure, we "planted" a stainless steel wire into the space created after removal of the nerve. A composite crown moulded entirely freehand from flowable composite was built up around the wire.

All done within an hour. The patient will be called back for the permanent crown which will be customised to match the colour of the other teeth.

Here is the tooth prepared for post crown.

A zirconia crown is fitted

Generally, zirconia does not have the same translucency as emax. However, they still look quite natural. Why zirconia? It's easily twice the strength of emax.

Wednesday, November 4, 2009

Have you ever facing the problem of seeking for experienced dentist with reasonable/cheap chargers in Singapore?

If it is YES, i would strongly recommended Polyclinic. But, do you have the time to queue up for the appointment? If you're having toothache right now, and what you need is root canal treatment ,wisdom tooth surgery. Singapore polyclinic will still refer you to the specialist. That might be fine with you. Of cause straight away you will be visiting the specialist to solve your pain. Another problem you have to face is to queue up at the specialist.

When you are having toothache, do you think you still have the patient to queue up for few days, a weeks or even take months for the appointment?

Well, you'll always have the second choice in your life. I am here to settle all the "problems" that you will be facing or you are having now. With the requirement of experienced dentist with reasonable/cheap chargers in Singapore.

Just email to me poohfa@hotmail.com . What's your problem ? we will try to solve and help your problem.

Tuesday, November 3, 2009

So what’s new? Kangaroo T shirts have gotten a bunch of outspoken fellows into trouble, stocks are still tumbling, Hong Kong’s financial regulators announced that they would guarantee all deposits for the next two years, using the territory’s foreign reserves as collateral, and our Finance Minister has once again said things that will leave many thinking Singaporeans scratching their heads.

“From the point of view of our system, it (guarantee for bank deposits) is not necessary because there is no lack of confidence in our system.”

Once in a while, I would get patients who want me to guarantee that their crown/bridge/implant will last x number of years. From a professional point of view, it is impossible to guarantee these services because there are so many biological variables involved. One patient may chew harder than another. One patient may brush harder than another. Another patient may love coffee, tea or wine. From an ethical point of view, it’s not honest or realistic for the dentist to guarantee. Some cases will fail and we all know it. But unlike ministers, we can’t declare that there is no lack of confidence in our services, “hence”, we can’t guarantee.

From a business point of view, however, it’s actually not too difficult to give such guarantees. The majority of cases will last x number of years. Even if the dentist has to redo some of those which don’t last x number of years for free, he is unlikely to suffer any losses as long as he has charged enough at the beginning. It sure is no fun having to redo a case that you’ve guaranteed but failed, but if it’s only 1% and if the guarantee boosts confidence and increases the absolute volume of your 99%, why not?

The same goes with well-known brands of electrical equipment. Even though consumers trust their products, brands like HP, Panasonic, Sony all guarantee their products. They are not worried about having to repair or even replace their products for free. Consumers know that the company will be able to afford it if their failure rate is low. With this knowledge comes confidence.

If any brand dares to stand out and say that there is no lack of confidence in their brand so they are not guranteeing it, then any discerning consumer will see the “logic” and quickly lose confidence in that brand. Why don’t you dare to guarantee if you are so sure that your system won’t fail? Nobody is going to cause me any anxiety by sticking his head out to guarantee my bank deposits. On the contrary, it’s reassuring to know that our “budget surplus” and massive “reserves” are not just things to boast about.

Monday, November 2, 2009

This middle aged lady has an obvious problem. Her 2 old crowns have come loose and her dentist failed to replace them in their original positions - which is understandable because they have detriorated so much.

We advised her to redo her PFM crowns with emax. After seeing what we have done for her daughter, she agreed.

The 2 old PFM crowns have deteriorated so much, it was impossible to seat them proper after they were dislodged. Notice the gap between the crowns as well.

Her original crowns were also protruding. She didn't have a choice of a better system back then.

Definitely warrants a redo.

We removed her old PFMs, masked the underlying colour.and impressions were taken.

The stumps were temporarily covered with temporary crown material.After 1 week later her emax crowns is ready .

Yes , she come for fit her 2 emax crowns. Now she get the better smile!

Acrylic dentures are not the best type of prosthesis for anyone, dentist or patient. Except for the rare, cynical grouch who is constantly in denial, no patient who has swapped his acrylic dentures for a set of shiny chrome dentures has ever regretted it. Chrome dentures are similar to acrylic dentures except in the base or framework of the prosthesis.

The teeth and "gums" used in a chrome denture are no different from those used in acrylic dentures. However, chrome, being much stronger than acrylic, allows a slimmer and sleeker design of the denture base. Not only can the base be thinner, it can also cover a smaller area of the mouth. Higher accuracy also provides a better fit. It's not surprising that in most cases, chrome dentures are superior to their acrylic equivalents. If function and durability are what you want in a denture, then go straight for chrome dentures.

The above denture demonstrates a situation called the free end saddle. When it occurs on both sides of the lower jaw, it is a challenge to the most skilled dentist. I would not advise anyone to have an acrylic bilateral free end saddle denture done. A good set of clasps on the remaining teeth will stop the denture from sliding backwards when the wearer bites. But the sinking force at the unsupported end may cause discomfort or even pain. A chrome denture may lessen the discomfort. Acrylic dentures almost always perform poorly under such circumstances.

Are there any disadvantages of chrome dentures over acrylic dentures? Well, first of all, chrome dentures are more expensive and take a longer time to construct. It is also important to note that chrome dentures often show more metal than acrylic dentures with thin wire clasps. Are you OK with the thick chrome clasps and rests? There are patients who deny that they are uncomfortable about the thick metal claps on their chrome dentures but keep complaining about other vague or non-existent problems instead. It is important to be frank with your dentist. However, one real problem with very large full upper chrome dentures, is the weight. In cases where the patient's upper jaw is not well-endowed with a high ridge or deep palate, full chrome dentures will be heavy and unretentive.

Sunday, November 1, 2009

This young actress showed up at our clinic with a hopeless premolar on her right side.

As her job requires her to look good in front of the camera all the time, she cannot afford to go without a tooth.

We extracted her tooth and inserted a tiny one-tooth Flexite immediate denture.

With pink coloured nylon claps and no coverage of her palate, she was able to look good before the camera and not have a denture plate interfere with her speech immediately after her extraction.

2 months after extraction, she came in for implant surgery. The healing was not very good and the bone quality not as good as we had wanted it to be, but we managed to insert a 4.5mmx8.5mm Osstem GSII implant into the space.

The extraction space after 2 months. Healing is not perfect, making the surgery a challenging one.The implant is in place. The blue fixture mount was removed and the wound was stitched up. She reported only mild discomfort after surgery and went straight back to work. The restoration phase of the treatment will take place in 3 months. We will post the updates then...

Monday, October 26, 2009

I heard from internet sources that dental implants last forever. A friend of mine had an implant done a few years ago and now it’s loosening. The dentist says my friend has poor hygiene. If implants last a lifetime, why is it that poor hygiene can cause it to loosen?Admin answer :

Dental implants MAY last a lifetime. Their durability is dependent on several factors. True, implants don’t decay, but like natural teeth, the gums and bone surrounding an implant can get infected due to poor oral hygiene.

Chronic inflammation “melts” away the bone holding the implant. Even with very good oral hygiene, some of the older designs of dental implants have microgaps inherent in the system which trap bacteria and cause chronic inflammation, giving rise to bone resorption even with good oral hygiene.

With better knowledge nowadays, dentists are less likely to use systems which have microgaps. Still, inflammation and bone resorption will set in if implants are not properly maintained.

Sunday, October 25, 2009

About Teeth whitening, have you ever wondered why almost every hunk or babe in the TV series Baywatch had such glistening white teeth? Well, of course no one would have paid too much attention to Pamela Anderson’s teeth, but the worst kept secret in Hollywood is, they all had their teeth bleached. That pearly white, “starry” smile used to be called the Hollywood smile. And it used to cost thousands of US$. Not anymore. The Hollywood smile has descended to the realm of mere mortals. Not only is tooth whitening readily available in dental practices all over the developed world, the cost for the procedure, like the US$, had come tumbling down.

The Bleaching Conspiracy?The moment tooth whitening became a mass market thing, something unfortunate happened. Marketing efforts by various manufacturers of dentrifices churned out an array of relatively cheap whitening gels, pastes and liquids which gave consistently poor results. One TV ad even said that with their product, nobody would ever need to pay their dentist hundreds of dollars for whiter teeth. Hardly any one of those products is still being sold in Singapore. Why were these products ineffective? Because the strength of peroxide (the active ingredient in bleaching gels) in them is too low. Meanwhile, at the dentist’s office, fanciful “laser whitening” procedures were performed. These procedures seemed to work very well, but within days, the teeth started yellowing again. In the end, they only worked marginally better than the OTC products but cost many times more.

Back in the good old days (20 years ago) dentists were taught that only non-vital, root canal treated teeth could be bleached. In those days, we would open up the pulp chambers of non-vital teeth, place hydrogen peroxide into the chamber and then, heat up the potent solution with a hot instrument. The whitening effect came fast and was very effective. Every science student can tell you that heating up hydrogen peroxide will cause it to decompose into oxygen and water. It’s the heat that speeds up the process and release whitening oxygen into the microscopic pores in the inside of the teeth.

Then, vital bleaching hit the market not long after I first started practising. Suppliers started telling us that even vital teeth which have not been root canal treated can be bleached with peroxide gel applied on the outer, non-porous surface of the tooth. It didn’t sound probable, but the “magic light” suspended our disbelief.

Fanciful light equipment like plasma arc lights, LED lamps, lasers etc burned holes through many a dentist’s pocket. It turned out that many dentists have either forgotten their basic sciences or somehow decided to go along with the suppliers’ marketing strategy. Light does not activate peroxide decomposition. Not plasma arc light and definitely not LED light which is cool. It’s heat that does it, so perhaps laser does work, but we can’t use heat on vital teeth or we’ll kill them. As far as bleaching is concerned, a safe, non-heat-generating light is a useless light.

Not only were some of these equipment bulky and expensive to rent, the hype generated by aggressive marketing tactics resulted in unrealistic expectations on the part of both dentists and their trusting patients who have paid about S$900 to S$1200 for mediocre results.

Tooth whitening with carbamide peroxide has been around for almost as long as I've been practising dentistry. However, very few dentists had their bleaching products flying off the shelves. I was curious enough to have tried out a wide range of products, encountered almost every kind of tooth discolouration and after countless complaints and praises, I more or less figured out some of the realities of tooth whitening. It’s not magic. It works for the majority of people but the degree of whitening varies from individual to individual. It doesn’t work for just anybody. Maybe that’s why not every lifeguard you see below is smiling. And the expensive, fanciful equipment are a big rip-off.

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